Titanium carbonicum: fear of criticism and failure

de Wiet van Helmond

CASE
Female 30 years old.

The patient was sent to me by her mother who told me the following beforehand:
She (her mother) was unable to get pregnant, so after trying for a long period of time she decided to try allopathic treatment which resulted in a twin pregnancy. In the seventh month labour started and she was brought to the hospital. She was told by the obstetrician that she should try to hold on to her babies as they would not live if they were born this early. This caused such a fright in the mother that even though the birth continued and she became fully dilated with contractions (dutch: persweeÃƒÂ«n), nothing happened. She was rushed to the O.R. for an emergency cesarean. (The mother told me that even now, 30 years after, she still has the feeling that if she lets her children go they will die.)
Both babies were brought into the world and while checking before closing the obstetrician noted a lump in the uterus, which was her, the third child in full breech. She was completely unnoticed for all these months.

The patient is now 30 years old and has studied psychology at the university.

As she is sitting across from me I can immediately notice a tremendous nervous excitement. It is a restless anxiety, she changes subjects very quickly and frequently saying “I think…” or “Let me think…” The essence of her story is that she is afraid she is not doing her work correctly. She’s terribly afraid of making mistakes or getting criticized.
She works as an individual counselor for psychiatric patients. She knows this job is something she is able to do, but that does not change the fact she is afraid someone will notice she is really not capable. In her spare time she studies all day to prevent mistakes and to keep up with all publications.
Because she is constantly reading, studying to avoid mistakes she has become stuck in theorizing everything. She keeps going over and over each case and is also endlessly trying to analyze herself. This has resulted in the current state she is in. She is so anxious she can read things, she does not take it in and on seeing a patient there is so much mental chaos, she is unable to create a plan of treatment. Someone has to help her on where to start. Once that is been pointed out she can continue from there. That means she is dependent and people will see her weakness, so this is the finishing touch on her never ending spiral of stress.
What strikes me is that the full weight of the stress lies on the aspect of her possible incapability and she has no stress on the consequences of this to her patients.

She has had this feeling in every job she ever had and it does not decrease if she works somewhere for a longer period of time. Each day feels as if it is her first day at work and she constantly feels she has to prove herself. She works harder then her colleagues and skips almost all of her lunch breaks for extra studying and preparing. But still, the insecurity remains. The anxieties started when she entered university, but they became extrme when she started working.

She calls her symptoms deep feelings of inferiority with a tremendous fear of not being capable and this being found out by co-workers. It has resulted in a tremendous amount of perfectionism. Nothing is ever finished and she will go on thinking about each case long after work.

The constant struggling causes an unhealthy amount of irritability which she will take out on her boyfriend now and then. She becomes especially irritated from the slightest noises he makes (rustling paper, walking downstairs, etc).

She makes lists of things to do and the number of lists just keeps getting longer and longer and she does not know where to start. As there are so many things to do (and all of them have to be done perfectly), she keeps putting things off because she gets lost in the details. Most of these lists are work related, but it also leaks into her private life. “I don’t know where to start and what should have priority.” Once someone tells her she can finish so she asks a lot of people what would they do, but she is also irritated if people tell her because she feels she should have known herself (projection).

She has been in a steady relationship for years and she has no insecurities whatsoever there. She is not afraid he will leave her or she will fail him somehow. She actually laughs when I ask her about confidence problems in the relationship, so it is purely work related.

Because her problem has been there for years and is causing her a lot of anxiety, she is also seeing a psychotherapist. He has diagnosed her as being ADHD, but she refuses to take Ritalin or any other allopathic medication.

Family: Her brother and sister are also insecure, but not as much as she is. Her mother has some insecurity problems as well, but no one has the chaotic, restless and anxious aspect.

Physically there are little symptoms. The only other symptom besides her obvious restlessness is an itching between her toes due to an infection and if she gets really anxious, she can get acute diarrhea.

Dreams: Mostly about work: making mistakes.

She has previously taken: calcium, baryta, cobalt, vanadium, thuja and zinc (and some others she does not remember), all without or with minimal results.

Follow-up 1:
After the first prescription of TITANIUM CARBONICUM MK.

She is a lot more relaxed. She decided to get a job where she can work more individually without so many people looking over her shoulder. The job interview went very well. There was no stress whatsoever and she says “I could actually present myself the way I am, not a mask. I may even have been to familiar with them.” She got the job.
Secondly, she thought it was time to take her relationship to the next level and so they got married (she had been indecisive on this for a long time). She is also looking for a house to buy because she does not want to rent anymore. And last but not least, she is considering expanding the family.
All of this happened in a period of about two and half months and her family also observed the progress in her state.

After this period she had a minor fall back after some criticism on her job so I repeated the MK.

Analysis :
It is clear that the remedy should be in the iron series: her problem only comes up in work situations. She is a very hard worker prone to perfectionism and there is a fear of being observed, failing and criticism.
The only problem is which one. If you look at the main miasm in this case it is between sycotic and cancer. So Cuprum would be indicated, but both Cuprum and Zincum did close to nothing. So I re-evaluated my notes and started looking at the iron series from the left/start and looked for where she was. What was the problem and when does it come up. Then it is obvious it is at the earlier stages where there is still a lot of trial and error. Over the last couple of years she has had several jobs and they all went in the same way. It is the constant conflict of “I can do this job so I should” against “I can’t do this job and they will find out.”
She is not taking jobs that are beneath her skills or that is just there for safety. She takes jobs where she is challenged everyday. So I felt Titanium is the closest one because it has so much doubt and gets paralyzed by this.
There are also typical symptoms for Stage 4: The anxieties started when she entered university, but they became extrme when she started working. So the start is the exciting factor, which is stage 4. Titanium is Stage 4 in the Iron series.

I still felt it was incomplete. During the first few consultations I tried to find out what was behind her insecurity, but she was too caught up in her indecisive chaos to be able to look that deep. The only thing that came up was a sense of not being good enough. Having no self worth, no reason to exist and therefore having to compensate by doing a good job. Now this is much deeper then titanium, but it felt out of reach. Now I needed something that would help her with the chaos and help her become more stable, because the slightest comment (and if there was no comment she would search for it) would bring her completely out of balance. This reminded me of the Carbons. I decided to go for the combination which worked well.

Follow-up 2:
After she had the remedy twice, a deeper layer is now presenting itself. She is now working on the part of why she has to work so hard. She is sliding from sycotic to psoric now. The chaos is still there sometimes, but it is different and she can now work at the deeper levels of her problem.